右美托咪定联合ERAS对老年钬激光碎石术患者的心肺保护作用及早期康复的价值  

Protective effect of dexmedetomidine combined with ERAS on cardiopulmonary and early rehabilitation of aged holmium laser lithotripsy patients

作　　者：刘浩 鲁金钢 赵延涛 LIU Hao;LU Jingang;ZHAO Yantao(Department of Anesthesiology,Hangzhou Xixi Hospital,Hangzhou 310023,China)

机构地区：[1]杭州市西溪医院麻醉手术科,浙江杭州310023

出　　处：《中国现代医生》2022年第33期9-14,共6页China Modern Doctor

基　　金：浙江省医学会临床科研项目(2018ZYC-A37)。

摘　　要：目的探讨右美托咪定联合加速康复外科(enhanced recovery after surgery,ERAS)对行钬激光碎石术老年患者的心肺保护作用及早期康复的价值。方法选取2019年1~12月于杭州市西溪医院接受钬激光碎石术的患者(年龄≥60岁)92例为研究对象,采用随机数字表法分为对照组与观察组,每组各46例。两组均予七氟烷联合瑞芬太尼静吸复合麻醉及喉罩通气,对照组予常规康复方式,观察组予右美托咪定辅助喉罩通气联合ERAS理念的康复方式,比较两组患者的血流动力学指标、肺功能指标、手术相关指标、术中镇静程度、术中及术后不良反应发生情况、术后各时间点疼痛视觉模拟评分(visual analogue scale,VAS)、术后苏醒时间、苏醒程度和术后早期生活质量评分。结果观察组患者的不同时间点心率(heart rate,HR)、平均动脉压(mean artery pressure,MAP)、血氧饱和度(arterial oxygen saturation,SaO_(2))均无明显变化(P>0.05);对照组在T1和T2时HR明显上升,MAP及SaO_(2)明显下降(P<0.05);其中观察组患者的HR、MAP、SaO_(2)、肺泡动脉血氧梯度(alveolar arterial oxygen gradient,AaDO_(2))、氧合指数(oxygen index,OI)与对照组比较差异有统计学意义(P<0.05)。观察组患者的麻醉时间和苏醒时间均短于对照组(P<0.05);观察组的Ramesay镇静程度显著高于对照组(P<0.05),警觉/镇静观察(Observer's assessment alert/sedation,OAA/S)评分明显低于对照组(P<0.05),两组患者的手术时间和一次性碎石成功率比较,差异无统计学意义(P>0.05)。观察组的不良反应发生率明显低于对照组(10.87%vs 28.26%,P<0.05)。观察组患者术后1h、3h和6h的VAS评分均明显低于对照组(P<0.05)。结论右美托咪定联合ERAS用于老年患者钬激光碎石术镇静效果显著,可有效稳定患者的术中各项生命体征,促进患者术后早期康复,并明显减少术中及术后不良反应,提高患者术后早期生活质量。Objective To investigate the cardiopulmonary protective effect of dexmedetomidine combined with ERAS in elderly patients undergoing holmium laser lithotripsy and its value in early rehabilitation.Methods A total of 92 patients aged≥60 years who underwent ureteroscopicholmium laser lithotripsy from January to December 2019 in Hangzhou City Xixi Hospital were enrolled.The study was conducted according to the random number table method,46 cases in each group.The two groups given sevoflurane combined with remifentanil combined anesthesia and laryngeal mask ventilation,the control group was given conventional rehabilitation,and the observation group was given dexmedetomidine assisted laryngeal mask ventilation combined with ERAS rehabilitation.Hemodynamic parameters,lung function indicators,and surgical related indexes.Intraoperative and postoperative adverse reactions,pain visual analogue(VAS)scores at various time points after surgery,intraoperative sedation,postoperative awake time,awake,early quality of life score were compared.Results There were no significant changes in HR、MAP、SaO_(2) values at different time points in the observation group(P>0.05).HR,MAP and SaO_(2) increased significant in the control group at T_(1) and T_(2),MAP and SaO_(2) decreased.HR、MAP、SaO_(2),A-aDO_(2),OI value in the observation group were significantly different from those in the control group(P<0.05).The anesthesia time and wake time in the observation group were shorter than those in the control group(P<0.05).Ramesay sedation in the observation group was significantly higher than that in the control group(P<0.05),and OAA/S score was significantly lower than that in the control group(P<0.05).The incidence of adverse reactions in the observation group was significantly lower than that in the control group(10.87%vs 28.26%,P<0.05).The VAS scores of the observation group were significantly lower than those of the control group at 1h,3h and 6h after operation(P<0.05).Conclusion The sedative effect of dexmedetomidine combined wit

关 键 词：钬激光碎石术 输尿管结石 加速康复外科 右美托咪定 老年 

分 类 号：R699[医药卫生—泌尿科学]